Social Anxiety Disorder Treatment and Therapy Social Anxiety Hierarchies A Pivotal Part of Behavior Therapy By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on January 22, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Siri Berting/Blend Images/Getty Images Social anxiety can be a debilitating condition, impacting your social life, family, and career. Depending on your form of anxiety, you may be nervous in all social situations or may only be triggered by very specific occasions. Social anxiety hierarchies are an ordered list of situations that trigger anxiety from least to most anxiety-inducing triggers. This process is an essential part of behavioral therapy. Anxiety hierarchies help you verbalize the situation that frightens you in specific terms, such as the exact settings, number of people around you or your role. By breaking the situation down into steps, you can see exactly what portions of social settings make you nervous. The different stages give you a process of confronting your fears in a gradual and safe manner. Determining Your Anxiety Hierarchy To determine your anxiety hierarchy, your therapist will work with you to establish a list based on situations that make you anxious. The most disturbing situation is placed on the bottom, the least disturbing at the top. Once the list is determined, your healthcare provider will help you work through the list step by step until you reach the final stage. Sample Hierarchy of Social Anxiety Below is an example hierarchy for someone with social anxiety who gets nervous mingling at parties:Taking part in a one on one conversation with a friendEngaging in a one on one conversation with a casual acquaintanceEntering into a one on one conversation with an unknown personSmiling at people you don't know at a partyTalking with one person you don't know at a partyEngaging in a conversation with three friends at a partyJoining a conversation with unknown people at a partyEntering a party or event where you don't know anyone Desensitization and Social Anxiety Hierarchy Desensitization therapy aims to remove fear from your anxiety-inducing situations and replacing that fear with relaxation techniques to obtain a calm and rational response. There are three parts of the desensitization process: Relaxation: Your healthcare provider will help you with relaxation techniques and breathing exercises to help you manage your nervousnessHierarchy: You will create an anxiety hierarchy based on your unique fears and situationPractice: Your therapist will help you work your way down the anxiety hierarchy, starting at the easiest item and working slowly through each step of the hierarchy until you can face the final and most anxiety-inducing step. It's important to not rush through this process. For people who are eager to stop their social anxiety, they often rush through the steps and will end up actually harming their treatment. By working slowly through the process, you can ensure that you are truly comfortable and relaxed. If going to the next stage induces anxiety, you can return to a lesser step in order to build on your relaxation training. Your therapist may recommend that you only go through the hierarchy during therapy situations so your healthcare provider can ensure you are safe and comfortable throughout the process. The number of sessions it takes to work through the hierarchy varies from person to person. Some phobias can be conquered in as little as four to six sessions; more severe cases will need several months of therapy. Find Help With the 7 Best Online Anxiety Support Groups Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. McLeod, S. "Systemic Desensitization". Simple Psychology, 2008. By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." 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